Patellar Dislocation / Instability Treatment Options
Patellar (kneecap) dislocation and instability can be the result of an acute trauma, chronically lax ligaments, bony malalignment, and/or soft tissue disorders. The majority of patellar dislocations occur in young women ages 10-16. Recurrent patellar instability is a disabling condition. When a young person suffers a patellar dislocation it causes great pain, limits mobility, alters the ability to walk and participate in sports. Patients with recurrent dislocations become apprehensive and guarded in fear of another possible subluxation.
Treatment options depend on the cause and severity of the instability. Physical therapy is usually the first choice of treatment. Surgery may be recommended if conservative treatment has failed.
Nonoperative treatment is the mainstay treatment for acute, first-time patellar dislocation with no loose bodies or damage to the joint cartilage and bone. Loose bodies are fragments of bone and cartilage caused by dislocation. If a loose body is present, surgery to remove the loose body may be indicated.
Nonoperative treatment involves over the counter anti-inflammatory medications, icing, rest and elevation for pain and swelling. Activity modification, short-term bracing for comfort and physical therapy to restore strength and mobility are also implemented. A good rehabilitation program is critical to improve lower extremity strength and improve patellar tracking. However, despite following a conservative treatment plan, the recurrence rate after nonoperative treatment can be as high as 44%.
Surgical treatment options
Chronic instability is treated based upon the underlying causes of the instability. General indications for surgery include damage to the bone and cartilage with loose bodies, chronic instability, and a failure of nonoperative management.
- When an acute first-time dislocation causes a ligament tear with bony fragment, the treatment is direct repair of the ligament and bone with open surgery within the first few days after dislocation.
- When the patient has recurrent instability with no malalignment, ligament reconstruction may be recommended to stabilize the joint.
- When the underlying cause is misalignment with degenerative changes, patellar realignment surgery will restore alignment.
- Most patients with recurrent dislocations will experience cartilage damage. When there is cartilage damage arthroscopic debridement, removal of loose bodies, can improve pain, and function and reduce the risk of arthritis. If the damage involves fractures of the bone and cartilage, arthroscopic repair with fixation may be recommended.
Contact Dr. Jeffrey Harrison to schedule a consultation to learn more about your options for patellar instability treatment.
Dr. Harrison is a board-certified fellowship trained orthopedic and sports medicine surgeon who specializes in arthroscopic knee and shoulder surgery. He is the Head Team Physician for the United States Alpine Ski Team and the Head Team Physician for Weber State University for over 20 years. Dr. Harrison completed his undergraduate degree at Baylor University and received his medical degree from the University of Arizona College of Medicine. He completed his orthopedic residency at the University of Utah followed by a fellowship in sports medicine at the Cincinnati Sports Medicine and Orthopedic Center. He finished his formal training with an additional AO Trauma Fellowship in Bern, Switzerland.
At a Glance
Dr. Jeffrey Harrison
- Board-Certified, Fellowship-Trained Orthopedic Surgeon
- Head Team Physician US Women's Alpine Team and Weber State University
- Performs over 800 surgeries per year
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